血管镜观察药物洗脱支架置入后支架表面内膜覆盖片

Bare-metal stent (BMS) Sirolimus-eluting stent (SES)
(Grade 3)
(Grade 1)
Stent: Bx Velocity 3.5×23mm Location: LAD mid
2.7 months f-up
Stent: Cypher 3.5×18mm Location: RCA mid 3.7 months f-up
A Case implanted both BMS and DES
59 y.o. female
Bx Verocity 3.018
Cypher 3.518
Follow up 3.7 months
Changes in Neointimal Coverage Grade
Sirolimus-eluting stent
(%)
PES (n=30)
SES (n=36)
PES vs. SES: p=0.002 by χ2 test test
Grade 0 Grade 1 Grade 2 Grade 3
Awata M, Nanto S et al. JACC Cardiol Intv 2009
Heterogeneity of Neointimal Coverage Grades
Post procedure
2020/11/4
Factors of Stent Thrombosis
Stent Thrombogenisity Patient / Lesion factors
•Material •Designs •Surface coating •Adjunctive therapeutic agents (drug, Radiation)
SES
(n=36)
53%
47%
Homogeneous Heterogeneous
PES
(n=30)
26%
48%
26%
Байду номын сангаас74%
PES vs. SES: p=0.0006 by χ2 test
Awata M, Nanto S et al. JACC Cardiol Intv 2009
Homogeneity
On 442 days of DES implantation, the patient developed AMI one week after aspirin was discontinued
because of surgical therapy of colon carcinoma.
Late stent thrombosis
30
Endeavor
Cypher
25
0.34±0.44 0.13±0.32
% of Patients
20
15
10
5
0 -0.6 -0.2 0.2 0.6 1.0 1.4 1.8 2.2 2.6
Insegment LL (mm)
2020/11/4
Summary
Angiographic findings of DES revealed ✓ Prolonged delayed growth of neointima ✓ Poor but homogenous covering over SES ✓ Heterogeneous luminal surface of PES ✓ White and homogenous appearance in patients treated with ZES: Basically grade 3 neoinitma A few yellow plaques and thrombi
Angioscopic Findings of Neointimal Coverage after Drug Eluting Stent Implantation
Shinsuke Nanto, M.D., PhD.
Department of Advanced Cardiovascular Therapeutics Osaka University Graduate School of Medicine
Bare-metal stent
n=11
3
n=10
n=4
Neointimal coverage grade
2
n=4
n=3
n=4
1
n=13
n=13 n=10
0
n=1
F４irstmfoollonwt-hups
n=1 Se1co2ndmfoollonwt-hups
Awata M, Kotani J, Nanto S et al. Circulation. 2007
Insegment LL (mm)
2020/11/4
Results of ENDEAVOR-III
Patient Frequency Distributions of In-segment Late Loss
% of Patients
30
Endeavor
Cypher
25
0.34±0.44 0.13±0.32
Kotani J, Awata M, Nanto S, et al. JACC. 2006
Neointimal Coverage Grades 3 to 6 Months After Stent Implantation
100
Sirolimus-Eluting Stent (n=15)
75
50
25
Honda Y and Fitzgerald PJ. Circulation 2003;108.
Angioscopic Findings of Neointimal Coverage after Drug Eluting Stent Implantation
Coronary angioscply Vecmova NEO™ (FiberTech, Tokyo, Japan)
Classification of Angioscopic Findings
QuickTime?遣 DV/DVCPRO - NTSC 闘恚蓈社蒓赦赡 菣潜敲蓅蒒蒨缮蔷濠侨菫墙菂钦颣髒黔菑臖
Grade 0
Grade 1
Grade 2
Grade ３
Grade 0: struts were exposed similarly to the time of implantation Grade 1: struts were covered, but not embedded Grade 2: struts were embedded by the neo-intima, but translucency seen Grade 3: struts were fully embedded and invisible by angioscopy
✓"Optimal late loss with homogeneous
coverage" may be desirable for adequate endothelial healing following stenting.
Biocompatibility
•Vessel size, Lesion length •Acute coronary syndrome
•Plaque characteristics •Local plt / coagulation activity
•Left ventricular function •Resistance for drugs
− Incidence of thrombi and yellow plaques were similar between the two groups.
Awata M, Nanto S et al. JACC Cardiol Intv 2009
Neointimal Coverage Grades at 8 months
Multiple stenting
Coronary blood flow
Procedure Related Factors •Morphometric abnormalities (Underexpansion, Asymmetry?) •Molphologic abnormalities (Dissection, Incomplete apposition Thrombus, Tissue protrusion) •Mechanical vessel injury •Anti-thrombotic therapy
Thrombi
P=0.2
Yellow plaques
P=0.004
(n=14)
(n=16)
(n=14)
(n=16)
Angioscopic Findings ZES vs. SES
8 mo. after implantation
11 mo. after implantation
Results of ENDEAVOR-III
Heterogeneity of 1 grade
Heterogeneity of 2 grade
Comparison of Angioscopic Findings SES versus ZES at 8 Months
Cypher 3.5×23mm
Endeavor 3.5×23mm
Awata M, Nanto S, et al. JACC. 2008
Neointimal Coverage Grades
at 8 months
In-stent ate loss
(%)
- SES = 0.07 ± 0.18mm